Sixth Circuit Finds 'Actual Charges' Term Ambiguous; Holds Insurer Liable For Fees Billed Rather Than Accepted As Payment

On June 21, 2012, in Pedicini v Life Ins Co, 682 F3d 522 (6th Cir 2012), the United States Court of Appeals for the Sixth Circuit affirmed the lower court's grant of summary judgment to the plaintiff insured on the basis that the term "actual charges" as it appeared in the plaintiff's insurance policy was sufficiently ambiguous to encompass the fees billed by the medical provider rather than the amount ultimately accepted as payment.

In Pedicini, the plaintiff held a supplemental cancer-insurance policy under which the cash benefits were to be paid directly to the plaintiff. The benefits conferred under the policy...